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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Page 1 <br /> 1868 E HAZELTON AVENUE <br /> STO 95205 <br /> Phone:e: (209(209) 46 468-3420 <br /> Account ID AR00 11757 <br /> INVOICE <br /> Facility ID FA0022785 <br /> Loommommmmmma <br /> Date Printed 1/26/2018 <br /> DELTA BLOOD BANK LLC RE : DELTA BLOOD BANK <br /> 3131 N VANCOUVER AVE 1030 N MAIN ST <br /> PORTLAND, OR 97227-1560 MANTECA, CA 95336 <br /> OWNER : DELTA BLOOD BANK LLC <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0300620•—Date of Invoice: 9/26/2017 I IIII IIII III VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII III VIII IIII IIII <br /> 9/26/2017 2220 SM HW GEN<5 TONS/YR $ 249.00 <br /> 9/26/2017 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 49.00 <br /> 12/15/2017 9994 PERMIT FEE PENALTY $ 249.00 <br /> Total for this Invoice $ 547.00 <br /> PAST DUE <br /> PAST DUE! TOTAL DUE this Billing Period $ 547.00 <br /> WE WOULD APPRECIATE YOUR <br /> PAYMENT TODAY! <br /> Please make Checks PAYABLE to: 'EHD' — Return a Copy of This STATEMENT with Your PAYMENT <br /> Penalties will be added to all Permit Fees For HMBP Fees For all SERVICE FEES <br /> at the Rate of 100%of the Base Fee Penalties will be added at the Rate of 10% Penalties will be added at the Rate of 10 <br /> 30 Days after the Due Date 60 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5254.rpt <br />